Zulfiqar A Bhutta a, Sajid Soofi a & Zahid Memon a

Bulletin of the World Health Organization 2008;86:988. doi: 10.2471/BLT.08.059493

We thank Yasir Bin Nisar for his interest in our pilot study1,2 as well as the comments on various aspects of the Pakistan National Programme for Family Planning and Primary Health Care, commonly called the Lady Health Worker (LHW) programme. Indeed the LHW programme has undergone many modifications since its inception in 19943 and, in particular, the last few years have seen an exponential growth in the number of LHWs as well as a streamlining of their activities and interventions. Our department has worked with the LHW programme for many years in several collaborative projects and has been closely involved with curriculum revisions, training aspects and pilot innovations.

Our paper represented the programme characteristics in relation to the preparatory and pilot phase (2000–2004) and the stipend for the LHWs for the time period specified was indeed 1800 Pakistani rupees (Rs). The travel costs mentioned relate to the allowances admissible for training and refresher courses. As Yasir points out, the stipend has recently been increased to Rs 2990 but, with the current exchange rate, this still translates to a mere US$ 37 per month.

Yasir is right in stating that the official “initial” training period for LHWs is 15 months, inclusive of the 3 month didactic period. However, we had estimated the standard training period to include the 15 months and didactic teaching as well as the regular monthly training sessions and refresher courses. Given the mean duration of service and experience of the LHWs in the Hala region, the average training period per individual is quite close to the stated average of 18 months in most cases. This point should have been stated with greater clarity in the LHW programme description. ■